SEP’s for CA, CO, KY, NY, OR & TX
SEP information provided by CIGNA – 3/7/2023
This is an important announcement for agents with customers in California, Colorado, Kentucky, New York, Oregon, and Texas and for those with business in those states. The counties below are under a state designated SEP due to an emergency.
CALIFORNIA
State declaration: Severe Winter Storms
SEP Incident Date: 03/01/2023 – Ongoing
This SEP declaration is effective: 03/01/2023 – Ongoing
Impacted counties for SEP purposes: Amador, Kern, Los Angeles, Madera, Mariposa, Mono, Nevada, San Bernardino, San Luis Obispo, Santa Barbara, Sierra, Sonoma, and Tulare
Declaration information Updated
FEMA declaration: Severe Winter Storms, Flooding, Landslides, and Mudslides
SEP incident dates: 12/27/2022 – 03/01/2023
This SEP declaration is effective: 12/27/2022 – 03/31/2023
Impacted counties for SEP purposes: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Inyo, Los Angeles, Madera, Marin, Mariposa, Mendocino, Merced, Monterey, Napa, Nevada, Placer, Sacramento, San Benito, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Tuolumne, Trinity, Tulare, Ventura, and Yolo
COLORADO
Declaration information Updated
FEMA declaration: Fuel Supply Chain Risk
SEP incident dates: 12/31/2022 – 05/31/2023
This SEP declaration is effective: 12/31/2022 – 05/31/2023
Impacted counties for SEP purposes: All counties
KENTUCKY
State declaration: Severe Winter Weather
SEP incident dates: 03/03/2023 – Ongoing
This SEP declaration is effective: 03/03/2023 – Ongoing
Impacted counties for SEP purposes: All counties
NEW YORK
Declaration information Updated
State declaration: Healthcare Staffing Shortages
SEP incident dates: 09/27/2021 – 04/21/2023
This SEP declaration is effective: 09/27/2021 – 05/31/2023
Impacted counties for SEP
Declaration information Updated
State declaration: Rikers Island Correctional Center Staffing Shortage
SEP incident dates: 09/28/2021 – 04/29/2023
This SEP declaration is effective: 09/28/2021 – 06/30/2023
Impacted counties for SEP purposes: Bronx, Kings, New York, Richmond, and Queens
purposes: All counties
OREGON
State declaration: Severe Winter Weather
SEP incident dates: 02/25/2023 – 04/30/2023
This SEP declaration is effective: 02/25/2023 – 04/02/2023
Impacted counties for SEP purposes: Multnomah
TEXAS
State declaration: Severe Winter Weather
SEP incident dates: 02/04/2023 – Ongoing
This SEP declaration is effective: 02/04/2023 – Ongoing
Impacted counties for SEP purposes: Anderson, Bastrop, Blanco, Burleson, Burnet, Caldwell, Delta, Denton, Falls, Hays, Henderson, Hopkins, Hunt, Kendall, Lamar, Lee, Leon, Milam, Red River, Robertson, Shelby, Smith, Travis, and Williamson
IMPORTANT: Please be aware
- This does not mean that active marketing can occur.
- The SEP is only for the purpose of providing a SEP to impacted individuals who had a valid election during the incident and were unable to make that election due to the emergency.
- This does not mean we initiate waiving of authorization or referral requirements.
- This does not extend waiving of prior authorizations, referrals etc.
SEP for Government Entity-Declared Disaster or Other Emergency
42 CFR 422.62(b)(18)
(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)
An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Individuals are eligible for this SEP if they:
- Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
- Were eligible for another election period at the time of the SEP eligibility period; and
- Did not make an election during that other valid election period due to the disaster or other emergency.The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends two full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.
Tips for completing applications
- Select “SEP” in the “Select Enrollment Period” field
- Enter code “DST” in the “SEP Code” field
- Enter the date the customer was affected by the disaster in the “SEP Date field”
- In the “Special Enrollment Period” section: Make sure you select the special enrollment period that applies to the customer in addition to selecting the “DST” box that states “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA)). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster.” Both are required to be completed.
For telephonic applications, ensure that the following fields are completed:
- In the “Special Enrollment Period section: Select the actual enrollment period the customer qualified for that was missed, and
- Select the check box next to the statement that reads “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency, or by federal, my state or my local government).One of the other statements on this page applied to me, but I was unable to make my request because of the disaster.” This creates the DST and the second code Enrollment requires to process the application.